BACKGROUND: The U.S. Food and Drug Administration recently approved tildrakizumab, a high-affinity, humanized, IgG1κ, anti-interleukin–23 monoclonal antibody for patients with moderate-to-severe plaque psoriasis. Understanding the comparative cost-effectiveness of tildrakizumab is important for health care payers and prescribers.
OBJECTIVES: To assess the comparative cost per month with a Psoriasis Area Severity Index (PASI) response for first-line tildrakizumab, adalimumab, apremilast, brodalumab, etanercept, guselkumab, infliximab, ixekizumab, secukinumab, and ustekinumab in treating moderate-to-severe plaque psoriasis from a U.S. health plan perspective.
METHODS: The 10-year cost-effectiveness analysis used a Markov model with five health states: four states based on PASI response (PASI 0-49, PASI 50-74, PASI 75-89, and PASI 90-100) and death. All patients received one of the treatments upon entering the model, respectively. Nonresponders, i.e., those who failed to achieve PASI 75 response, were withdrawn from their current treatment; 25% received either topical therapy, phototherapy, or other systemic therapy, and 75% received the basket of remaining comparators as a second-line therapy before receiving topical therapy, phototherapy, or other systemic therapy. Network meta-analysis of published clinical trial data provided PASI response rates. Total cumulative months in which a patient achieved at least a PASI 75 response was estimated. Total costs consisted of drug acquisition and administration, laboratory tests, and clinical visits.
RESULTS: Compared with topical therapy, phototherapy, or other systemic therapy, the incremental cost per month with PASI 75 was lowest for brodalumab ($3,516), infliximab ($3,665), and apremilast ($4,365), followed by tildrakizumab ($4,816), secukinumab ($4,972), guselkumab ($5,351), adalimumab ($5,369), ustekinumab ($5,485), ixekizumab ($5,495), and etanercept ($5,771). The position of tildrakizumab relative to the other treatments remained the same across multiple scenarios investigated.
CONCLUSIONS: Tildrakizumab is among the most cost-effective first-line therapies for treating moderate-to-severe plaque psoriasis and is more cost-effective than secukinumab, guselkumab, adalimumab, ustekinumab, ixekizumab, or etanercept.
